Table 1 Patient characteristics, ICI treatment history, symptomatology, and endoscopy findings
Patient | Age | Sex | Malignancy | History of other ICI exposure | ICI type and dose | Days (doses) to onset of symptoms post ICI | Diarrhea grade | Other symptoms | Colitis grade | Endoscopic features | Histopathologic features |
|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 75 | M | Meningioma | None | Pembrolizumab Dose: 3 mg/kg Frequency: every 3 weeks | 39 days (2) | 1 | None | 2 | Colonoscopy: Sigmoid colon: localized moderate inflammation characterized by altered vascularity, congestion (edema), friability and granularity | Colonoscopy: - Ileum: mucosa with hyperplastic Peyer’s patches and no diagnostic abnormality - Ascending colon: mucosa with lymphoid aggregate and no diagnostic abnormality - Sigmoid colon: moderately active colitis with neutrophilic cryptitis and crypt abscesses |
2 | 58 | F | Colon | - Pembrolizumab (stopped 2 years prior to current ICI): no adverse effects but disease progression | Ipilimumab/Nivolumab Dose: Ipilimumab-1 mg/kg, Nivolumab- 240 mg (3 mg/kg) Frequency: combined every 6 weeks (4 doses total) followed by nivolumab alone every 2 weeks | 8 days (1) | 2 | Abdominal pain | 2 | Upper endoscopy: - Gastric antrum: diffuse moderately erythematous mucosa without bleeding - Duodenum: an acquired benign-appearing, intrinsic moderate stenosis in the first portion of the duodenum | Upper endoscopy: - Gastric antrum/fundus/body: active chronic gastritis - Duodenum: mucosa with ulceration, crypt dropout, marked expansion of lamina propria with prominent eosinophils and acute inflammation - Duodenal stricture: mucosa with mild expansion of the lamina propria |
3 | 70 | F | Melanoma | - PD-L1 inhibitor (as a part of a clinical trial): for a total of 1 year (stopped 3 years prior to current ICI). No adverse events but disease recurrence - Pembrolizumab: 200 mg 3 (mg/kg) every 3 weeks for total of 8 doses (stopped 1 year prior to current ICI): no adverse events but disease progression | Ipilimumab Dose: 3 mg/kg Frequency: every 3 weeks | 35 days (2) | 2 | Nausea, vomiting | 2 | Upper Endoscopy: - Stomach: normal - Duodenum: diffuse moderately scalloped mucosa Flexible Sigmoidoscopy: - Colon: examined portion was normal | Upper Endoscopy: - Duodenum: diffuse active duodenitis with villous blunting, expansion of the lamina propria with mixed inflammation, and reactive epithelial changes - Stomach: antral mucosa with edema and mild patchy inflammation Flexible Sigmoidoscopy: - Colon: normal |
4 | 73 | M | Melanoma | Atezolizumab (in combination with cobimetinib): total of 13 cycles (stopped 2 weeks prior to current ICI) | Ipilimumab/Nivolumab Dose: Ipilimumab-3 mg/kg, Nivolumab-1 mg/kg Frequency: combined every 3 weeks | 11 days (1) | 2 | Nausea, vomiting, abdominal pain | 2 | Upper Endoscopy: - Stomach: non-bleeding erosive gastropathy - Duodenum: diffuse mildly congested mucosa without active bleeding Colonoscopy: - Sigmoid and descending colon: discontinuous areas of nonbleeding ulcerated mucosa with no stigmata of recent bleeding | Upper Endoscopy: - Stomach: active gastritis with small stromal granuloma in antrum. Active gastritis with stromal histiocytes in the body - Duodenum: active duodenitis with villous injury Colonoscopy: - Descending colon: focal active colitis with stromal histiocytes - Colon and sigmoid ulcers: severely active colitis with ulceration |
5 | 79 | F | SCC | None | Cemiplimab Dose: 350 mg Frequency: every 3 weeks | 14 (1 dose) | 1 | Nausea, vomiting | 2 | Upper Endoscopy: - Stomach: Non-bleeding erosive gastropathy - Duodenum: normal Flexible Sigmoidoscopy: - Colon: Inflammation characterized by congestion (edema), erythema and granularity | Upper Endoscopy: - Stomach: reactive gastropathy and intestinal metaplasia - Duodenum: normal Flexible Sigmoidoscopy: - Colon: mucosa with mildly increased cellularity of the lamina propria and epithelial injury. Focal acute inflammation is also noted, but there is no increase in apoptosis. |